Why Does Plantar Fasciitis Keep Coming Back?

Key points in 30 seconds

1. The plantar fascia gets less blood flow, so it takes time to heal.
2. If only the inflammation is calmed down, the cause remains and it hurts again.
3. Supporting the arch and the way you walk need to be looked at together.
4. You can't rest your feet, so we change the way you use them.
5. If it hurts at night too, or is swollen and warm, tests come first.

What we often hear

• "My first step after waking up is a stabbing pain."
• "It gets better, and then before long it's back again."
• "I'm afraid to walk."

Why does plantar fasciitis keep coming back?

Because only the pain is calmed down while the way you use your feet stays the same. Even after the inflammation settles, if the same force keeps landing on the same spot, it swells again.

A typical sign is a stabbing pain in the heel with your first step in the morning. After a few steps it eases and seems to be getting better, but after walking or standing for a long time, it hurts again. This cycle often goes on for months.

Why doesn't it heal well?

The plantar fascia is tissue similar to a tendon, so it has fewer blood vessels than muscle. Because less blood flows through it, the inflammation takes longer to settle.

Two more things add to this. One is that the foot arch stays collapsed, and the other is that the way you walk stays the same. When the arch sinks, the plantar fascia stretches more with every step, and that stretching is repeated thousands of times a day.

Does that mean three things have to be looked at together?

Yes. Calming the inflammation, supporting the collapsed arch, and changing the way you walk. Do only one of the three, and the other two drag it back down.

The most common mistake is doing only the first. People calm it down when it hurts, stop once it's okay, and a few months later the same spot hurts again. It's not that it didn't get better; the cause was still there.

Why not rest it, like with a cast?

Because the foot is hard to rest. When a bone breaks, a cast can hold it still, but you can't go about life without walking.

So the approach is different. Instead of not using the foot, we change the way it's used. When the foot arch is supported, the stretch on the plantar fascia is smaller even with the same steps. In a sense, you get an effect similar to resting while still walking.

What are the limits of this explanation?

This article summarizes what we've seen in the clinic, and we don't have numbers on how much recurrence went down when all three were done together.

One more thing. Not all heel pain is plantar fasciitis. It may be a stress fracture of the heel bone, a pinched nerve, or, rarely, a tumor or infection. If the painful spot hurts at night too, is swollen and warm, or doesn't improve at all with rest, imaging comes first.

We start by finding out why it keeps coming back. If only the painful spot is treated, the collapsed shape of the foot stays the same, and a few days later the same spot hurts.

If painful first steps in the morning keep coming back, come see us. Finding the reason it recurs comes first.

How fast things improve depends on how collapsed the arch is and how much you walk each day.